Obamacare failed because government is too small - no, really

At this point, we don't know if the Affordable Care Act will eventually succeed and endure, and anybody who tells you it will or won't is indulging in ideological wish fulfillment. What does seem clear is that unless circumstances change, it will fall short of its original goal of insuring 27 million Americans by at least 5 million people--and perhaps many, many more. These shortcomings, however, are a result of government being too small--too clipped, constrained, underfunded and underpowered--to achieve Obamacare's policy aims, not vice versa.

Here's how the Affordable Care Act ran into trouble. The drafters of the law planned to insure 16 million poor and near-poor Americans through an expansion of Medicaid. As a carrot, they fully funded the expansion at the outset and funded 90 percent of it by 2020--a formula much more generous than what's currently offered. As a stick, they designed the law so that states that refused the expansion would lose their Medicaid funding. When the Roberts Court upheld the individual mandate (the requirement that Americans purchase health insurance or face tax penalties), it also broke that stick, allowing states to opt out of the expansion without penalty. Since then, twenty-one states, all of them controlled by Republicans, have done just that. As a result, about 5 million Americans, the majority of whom are people of color in the South, will fall into a coverage gap. They are ineligible for Medicaid and will be required to purchase insurance. At the same time, they are too poor to qualify for the ACA's subsidies. But nota bene: the plight of these poor Americans is not a result of any flaw in the original law; it's due to the Roberts Court's gutting of one of the law's crucial levers and the wave of GOP cruelty politics that ensued.

"Cruelty politics?" This guy has apparently never tried to get on the healthcare.gov website:Chinese water torture and the Spanish Inquisition all rolled into one.

A single-payer system would certainly have been simpler, better and ultimately more cost-effective. So would an expansion of Medicare and Medicaid along with a nationwide public option. Either proposition would vastly expand the reach of the federal government. Anyone interested in building public support for such a shift can do so by cutting through Republican spin about the reasons for Obamacare's failures and getting at the truth: far from being too big to work, it was chipped away by opponents who hope it's becoming too small to succeed.

The argument has the virtue of never having been used before. It's a novel approach to big government advocacy; a government that spends $3.7 trillion a year - almost 1/4 of the GDP - isn't big enough. I welcome the attempt to sell this idea to the American voter - if they'll listen. Unfortunately for liberals, they will be too busy tarring and feathering every lefty they can get their hands on who pushed this monstrosity of a law on the rest of us.

Sometimes, we should just sit back and let liberals reveal how monumentally stupid they really are.

At this point, we don't know if the Affordable Care Act will eventually succeed and endure, and anybody who tells you it will or won't is indulging in ideological wish fulfillment. What does seem clear is that unless circumstances change, it will fall short of its original goal of insuring 27 million Americans by at least 5 million people--and perhaps many, many more. These shortcomings, however, are a result of government being too small--too clipped, constrained, underfunded and underpowered--to achieve Obamacare's policy aims, not vice versa.

Here's how the Affordable Care Act ran into trouble. The drafters of the law planned to insure 16 million poor and near-poor Americans through an expansion of Medicaid. As a carrot, they fully funded the expansion at the outset and funded 90 percent of it by 2020--a formula much more generous than what's currently offered. As a stick, they designed the law so that states that refused the expansion would lose their Medicaid funding. When the Roberts Court upheld the individual mandate (the requirement that Americans purchase health insurance or face tax penalties), it also broke that stick, allowing states to opt out of the expansion without penalty. Since then, twenty-one states, all of them controlled by Republicans, have done just that. As a result, about 5 million Americans, the majority of whom are people of color in the South, will fall into a coverage gap. They are ineligible for Medicaid and will be required to purchase insurance. At the same time, they are too poor to qualify for the ACA's subsidies. But nota bene: the plight of these poor Americans is not a result of any flaw in the original law; it's due to the Roberts Court's gutting of one of the law's crucial levers and the wave of GOP cruelty politics that ensued.

"Cruelty politics?" This guy has apparently never tried to get on the healthcare.gov website:Chinese water torture and the Spanish Inquisition all rolled into one.

A single-payer system would certainly have been simpler, better and ultimately more cost-effective. So would an expansion of Medicare and Medicaid along with a nationwide public option. Either proposition would vastly expand the reach of the federal government. Anyone interested in building public support for such a shift can do so by cutting through Republican spin about the reasons for Obamacare's failures and getting at the truth: far from being too big to work, it was chipped away by opponents who hope it's becoming too small to succeed.

The argument has the virtue of never having been used before. It's a novel approach to big government advocacy; a government that spends $3.7 trillion a year - almost 1/4 of the GDP - isn't big enough. I welcome the attempt to sell this idea to the American voter - if they'll listen. Unfortunately for liberals, they will be too busy tarring and feathering every lefty they can get their hands on who pushed this monstrosity of a law on the rest of us.